- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.00 / $4,826.00 / $14,100.00
| Facility | | $1,456.00 | $4,826.00 | $14,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,954.18 / $11,106.95 / $17,552.49
| Facility | | $6,954.18 | $11,106.95 | $17,552.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.78 / $2,545.78 / $2,545.78
| Facility | | $2,545.78 | $2,545.78 | $2,545.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.58 / $650.91 / $8,753.15
| Facility | | $457.58 | $650.91 | $8,753.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $5,407.00 / $9,232.95
| Facility | | $1,481.00 | $5,407.00 | $9,232.95 |